California S Coordinated Care Initiatve

CALIFORNIA’S COORDINATED CARE INITIATVE

CAL MEDICONNECT

MARCH CCI STAKEHOLDERS CALL Page 22

Female: Hi, good morning and welcome to the March CCI Stakeholder call. I’m just gonna go through a little bit of housekeeping before we dive in today. If we get disconnected, just give us a couple minutes and dial back in using the same information and we will be back online as soon as we are able. Uhm -- and just to make sure that folks can hear us okay -- uhm -- can you press 1 to raise your hand if you can hear us? Okay, great. Looks like folks can hear us. And if at any point, you want to ask a question to be put into the cue for the call, go ahead and press 1 again and we will try to get to folks as -- uhm --as they raise their hands. So, we have a -- an action packed agenda today. We’re gonna go over the enrollment dashboard, the performance dashboard. We’re gonna hear from -- uh -- the Cal MediConnect Plan in San Diego on some exciting work they’re doing in the behavioral health integration space and go over -- uhm -- go over some -- uh -- materials that are forthcoming for -- for Cal MediConnect. Uhm -- so with that, we will start off with an enrollment update from Javier Portella (phonetic).

Mr. Portella: So, hello everyone. I’m Javier Portella with the Department of Healthcare Services. Uhm -- I’ll be going over the Cal MediConnect -- uhm -- February monthly enrollment dashboard as the March dashboard is on its way to be released. Uhm -- with the February dashboard -- uh -- with -- uh -- passive stock, we’ve redesigned a lot of the dashboard views over the past couple of months in trying to keep it -- uh -- in addressing areas that are -- uhm -- you know, more active in the dashboard environment. And so the most active county today is Orange County. Uh -- for May 1 enrollment, they’re still mailing out as well as for our April 1 enrollment -- uh -- targeting around on average about 3,000 to 3,200 individuals -- uhm -- being noticed and potentially enrolled through the process. Our total enrollment is at 124,292. And our call center continues to see -- uh -- a decent volume of calls. About 2,000 a week. And what we’re seeing -- and so we continue to maintain our call center staff and work through members’ calls and questions about enrollment, disenrollment or changing class. As you know -- uh -- for (unintelligible) in Orange County, they do conduct their own enrollments. Our HEO (phonetic) call center activity is actually related to non-(unintelligible) counties that are -- uhm -- completed their (unintelligible). And so these calls are coming from members that would like to opt in, change their plan or potentially disenroll into a Medi-Cal plan only. Our opt out numbers are staying static as the opt out is only a factor when passive has begun. So, Orange is the only county that continues to move at this point. And so we’ll see the numbers -- uhm -- become very static over time. Uhm -- and Orange will have its continual adjustments until the passive is complete. And so the -- the opt out numbers will stop being adjusted for counties that are no longer in the passive phase if -- if it’s not relevant to continue to look at the populations and consider them opting out or not. The second part of the enrollment dashboard that gets released is the Cal MediConnect opt out breakdown by language, ethnicity in age by county. And so you’ll see a few things here in the dashboard. There’s not any real significant change in the counties and there will be no change in the counties that are completed their -- uhm -- passive phases. However, in Orange County, you’ll see a little bit of fluxuation, but between the two months, there’s been really zero change from a -- a language standpoint wherein Orange -- uhm -- Korean, Vietnamese, Asian or Pacific Islander continues to be the -- the higher as well as -- uhm -- in the language and -- uh -- in the ethnicity race area, in the language area, India, Chinese and Korean continue to be some of the top -- uhm -- opt out percentages in the Orange County arena. That completes the dashboard relevant to enrollment. As we have seen, we’ve -- uh -- kind of minimized the views on the dashboard for February, possibly -- uhm -- and March, you’ll see the same thing. That way we can continue to focus on the areas that move -- uh -- such as the enrollment number, the call center numbers as well as the Orange County monitoring or the notices that Cal Optima does -- uhm -- for the demonstration. And I think we’ll move on to next our --

Female: Great.

Mr. Portella: -- before we take any questions on anything at the end.

Female: All right, sounds good. Nathan.

Mr. Allen: All right, thank you Javier. And so this is Nathan Allen (phonetic). I’m (unintelligible) for the Managed Care Quality and Monitoring Division. And today, I’m gonna be walking through the Cal MediConnect performance dashboard. So, this is the first iteration that’s been released, probably was released about a week ago and it will be released quarterly prospectively from here on out. So, page one of the dashboard focuses on HRA -- uhm -- completion rates. So, you’ll notice -- uh -- Figure 1.1, you have an overall completion rate. Uh -- Figure 1.2 we have completion per plan. And then down on the bottom of the dashboard, we have some different ways of looking at the data that helps put HRA completion rate in perspective. So, some of the things that I wanted to point out on page 1 that you’ll notice throughout the dashboard is we do use this as a monitoring tool. And we do -- uhm -- add footnotes when we’ve identified things so there’s better perspective publicly on what’s happening. So, I wanted to call out the footnotes on page 1 just as an example. Note 1-3 refers to Figure 1.3. You’ll notice Cal Option did not report any data for this time period; however, they just started voluntary enrollment. So, there was basically no data available. However, from a data quality perspective, if you were looking at the dashboard or developing it, that would be cause for concern and would be something that we would look into. Uh -- note 1-4 refers to -- uhm -- chart 1—also 1.4 and you’ll notice the substantial spike in quarter one of 2015 and that’s because there was a substantially large amount of beneficiaries that were being enrolled and the additional HRAs that were being attempted. Moving on to page 2, it’s additional ways to look at HRA breakdowns. We feel it’s very important for beneficiaries to be enrolled in Cal MediConnect and be assessed immediately. So, we wanted to dedicate a lot of -- uhm -- data and charts for HRAs. One thing I wanted to note on this page is you look at the chart on the top, Figure 2.1, on the far right under San Francisco Health Plan, in purple which stands for not completed, 45.3% rate. So, one of the things that we do with this dashboard again is we monitor and we follow up and what we had identified with -- uhm -- this item is that there was some technical assistance -- uh -- provided for the plan and they are submitting additional data. And so as we move on to presenting these dashboards on a quarterly basis to the public, we’ll note when data has been adjusted. So, likely next quarter you’ll see the -- uhm -- data element adjusted. So, I just wanted to call that out. As we move forward with presenting these, you’ll -- we’ll -- we’ll do that more often. Moving on to page 3, this is our appeals page. So, Figure 3.1 shows overall determination, fully favorable, partially favorable and adverse. Partially favorable is defined as (unintelligible) -- uhm -- but there’s multiple items in the field and one or more is not resolved in the beneficiaries’ favor. So, we also have appeals breaken down by per thousand members and we have a dotted line that shows the average. So, you’ll -- you’ll notice that the appeal rates per 1,000 members are very low. And so there is gonna be situations where there is either a zero or a very low -- uh -- appeals being filed per 1,000 members such as 23 IEHP. Uhm -- we also have it broken out by plan (unintelligible). So, moving on to page 4, this is where we start talking about more of the utilization data. So, we have information and data available on discharges that resulted in ambulary care follow up -- uhm -- with it being trended and emergency utilization data with it also being trended. And the last page of additional -- uhm -- utilization data, we have it by LTFS which is the different LTFS categories. Also trended, and at the bottom of the page, we have members contacted by their Case Manager -- uhm -- also with an averaged -- uhm -- dotted line that represents the average -- uhm -- for all -- all plans, all counties. In terms of -- uhm -- the dashboard itself, if you’re familiar with the Medi-Cal Managed Care dashboard, and how we’ve watched them roll that out, what we normally do is we would launch the dashboard, we would have it for a couple of quarters and then from there, we would start rotating measures on and off the dashboard. As we start the process, we will reach out and receive public comment on things that people would like to see on dashboard, how it measures like to be adjusted or presented. So, this process will likely start in a quarter or two. But wanted to call that out and as we move through these -- uhm -- presentations, we’ll start talking about that more.

Female: Great, thanks Nathan. Uhm -- it doesn’t look like we have any questions on the dashboard. Okay, we’re gonna go ahead and move onto the next item on the agenda. So, we are going to unmute the line of George Scolari (phonetic). George is the Behavioral Health Program Manager for Community Health Group. Uhm -- and since 1998, he has chaired the Healthy San Diego Behavioral Health Workers -- uhm -- and we are really glad to have him on the line with us this morning to talk through some of the exciting work that’s happening -- uhm -- in San Diego around behavioral health integration. So George, I’ll hand it over.

Mr. Scolari: I’m here. Thank you for having me. So again, I’m George Scolari with Community Health Group. I handle our behavioral health services going back to 1993 before specialty mental health was even carved out of Medi-Cal managed care plans. So, I’ve been around a while and in San Diego County, our health plans operate for Medi-Cal under an umbrella called Healthy San Diego. I think most people on the phone have probably heard of Healthy San Diego. We started in July of 1998 and there’s sort of a Board of Directors and Quality Improvement Committees and multiple work groups underneath that. And I chair -- uhm -- a number of them, including behavior health. Uhm -- one of our workers with the County of Aging of Independent Services and a new one for Health and Housing looking at future -- uhm -- programs like the Whole Person Care pilot. So, we’re getting prepared for all those things. Within our behavioral health workgroup, when the Coordinated Care Initiative started, it made sense to us in San Diego County since all the health plans had such a longstanding relationship working under the behavioral workgroup with our County behavioral system. That anything we did for the CCI and especially for -- uh -- Cal MediConnect, that it came out of that workgroup which is, to date, about 88 people -- uhm -- involved, including the head of our County Behavioral Health, our Behavioral Health Director and their Clinical Director and Executive team, all the health plans, including our health plan medical directors and advocates and hospitals -- uhm -- education. I think you name it, we have them at the table. So, for Cal MediConnect, we started meeting very early on to set up the MOU which we were, I believe, the first county to get that signed, sealed and delivered to the Department of Healthcare Services and set up our six policies and procedures which were required and did a huge amount of training with our County organizational providers. Both through the county mental health clinics and part of the -- the Cal MediConnect requirement was the health plans needed to contract with them and make sure that dual members enrolling in Cal MediConnect would continue to receive the wonderful services provided within the County system. So, we did a number of things. We did, I would say about 20 different trainings to the different County mental health managers and directors which they would take back to their staff to teach them what Cal MediConnect and how they’re gonna work with the health plans. And then on February 2014, we did a large kickoff event where 150 top management people from these county programs attended and speakers included Alfredo Aguirre our -- our Director of Behavioral Health for San Diego County, Dr. Michael Crelstein -- uhm -- their Clinical Director, Greg Knall (phonetic) who is -- uhm -- an attorney and oversees the Consumer Center for Health Education Advocacy, (unintelligible) Society and of course, people know is the -- the Ombudsmen program for Cal MediConnect. These were all speakers, along with myself, doing a recap of all those trainings we had done with County behavioral health providers. We learned a lot during these trainings and after that very successful and fun event, it was -- uhm -- about three hours long, a lot of the program said we need on more training. So, two weeks later we went back and got them all together because there was some detailed information that -- that we needed to provide them. We hadn’t -- uh -- you know, lessons learned I guess and so out of that came creating -- uh -- behavioral health contact card. Uhm -- we called it a Care Coordination Card and to help these County behavioral health programs, we gave them one single card that listed the four health plans which are care first, community help group, HealthNet and Molina. Who their contact numbers are, their different -- uhm -- customer service numbers, websites, provider websites, 24-hour nurse lines, pharmacies. Explain to them what a Pharmacy Benefits Manager is and how those services worked.